"In God we trust; all others bring data".

My last several columns reflected upon the paucity of rigorous scientific methodology used to generate evidence in support of the positive outcomes reported by pharmacists’ direct patient care services. I have received both positive and negative comments about these pieces. I continue to encourage readers to supply examples of literature reflecting pharmacists’ actions and will reflect upon one example this month. The benefits of medication synchronization programs appear in a white paper2 complete with an online implementation guide3 explaining how community pharmacists can engage with the “consumer” to improve adherence. The APhA Foundation dedicates several webpages to medication synchronization under the header “Align My Refills,” including a pharmacy locator function.4 Some states have introduced laws providing reimbursement to pharmacists for partial filling of prescriptions in order to synchronize the due date for patients’ chronic medications (my preferred term).5 Finally, according to a Drug Store News article, “more than 1,600 community pharmacies are providing medication synchronization services to more than 70,000 patients nationwide through established medication synchronization programs, including NCPA’s [National Community Pharmacists Association] Simplify My Meds program, which is used by more than 1,100 independent community pharmacies nationwide.”6 The article even includes a table depicting the enhanced adherence among patients whose medication refills have been synchronized. To be clear, this is not a critique of the need for or value of medication synchronization programs. It is clear from data published in peerreviewed journals that requiring patients to return to their community pharmacies more than once a month decreased medication adherence by 46%.7 Further peer-reviewed support of refill synchronization includes a 2013 quasi-experimental study that demonstrated improved persistence rates of 66.1% to 75.5% compared with 37% to 40.8% in nonsynchronized patients.8 The authors of the 2013 manuscript, however, noted the shortcoming that there are no patient clinical outcome data to correlate to improved persistence. Just this month, the lead author of the 2013 manuscript published an additional, retrospective study in which patients selected a medication synchronization date.9 On this date, or appointment, patients would pick up their medications after authorizing the pharmacist to contact the physician and obtain any prescriptions necessary to achieve synchronization. After a 1-year period, those participating in the synchronization program—despite having higher adherence rates at the outset—demonstrated statistical improvement in both adherence and persistence. Participation led to 17 to 40 more patients possessing medications for greater than 80% of the prescribed time period. A key distinguishing feature of this study was that it enrolled patients who had already been on chronic medications for at least 6 months. This most recent study offers additional evidence in support of medication synchronization programs, suggesting not only that patients with new prescriptions would likely benefit, but does so in a peerreviewed format. We must now pro‘In God we trust; all others bring data’1